Sexual dysfunction or sexual malfunction refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including desire, arousal or orgasm. For men, erectile dysfunction or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. There are various underlying causes, such as damage to the nervi erigentes which prevents or delays erection, or diabetes, which simply decreases blood flow to the tissue in the penis, many of which are medically reversible. There are many factors which may result in a person experiencing a sexual dysfunction. These may result from emotional or physical causes.
Sexual dysfunction may arise from emotional factors, including interpersonal or psychological problems. Interpersonal problems may arise from marital or relationship problems, or from a lack of trust and open communication between partners, and psychological problems may be the result of depression, sexual fears or guilt, past sexual trauma, sexual disorders, among others. Sexual dysfunction is especially common among people who have anxiety disorders. Ordinary anxiousness can obviously cause erectile dysfunction in men without psychiatric problems, but clinically diagnosable disorders such as panic disorder commonly cause avoidance of intercourse and premature ejaculation.
Physical damage can of course be a major contribution to sexual dysfunction. One leading physical cause of ED is continual or severe damage taken to the nervi erigentes. These nerves course beside the prostate arising from the sacral plexus and can be damaged in prostatic and colo-rectal surgeries.
In fact, the relationship between lower urinary tract symptoms (LUTS) and sexual dysfunction is well established and highly prevalent (Rosen R., Altwein J., Boyle P., et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol 2003; 44:637-49). Both disorders can impact quality of life and may share a common pathophysiology (McVary K. Lower urinary tract symptoms and sexual dysfunction: epidemiology and pathophysiology. BJU Int 2006; 97 (Suppl 2): 23-8, discussion 44-5). The efficacy of surgical treatments such as transurethral resection of the prostate (TURP) on LUTS due to benign prostatic hyperplasia (BPH) is well established. However, the effect of surgical treatment of bladder outlet obstruction (BOO) due to BPH on sexual function is not clear. Several authors have found that surgical treatment of BOO can impair sexual function (Muntener, M., Aellig, S., Kuettel R., Gehrlach C., Susler T., Strebel R. Sexual Function after Transurethral Resection of the Prostate (TURP): Results of an Independent Prospective Multicentre Assessment of Outcome. European Urology 52 (2007) 510-516; Briganti A., Naspro R., Gallina A., Salonia A., Vavassori I., Hurle R., Scattoni E., Rigatti P., Montorsi F. Impact on Sexual Function of Holmium Laser Enucleation Versus Transurethral Resection of the Prostate: Results of a Prosspective, 2-Center, Randomized Trial. The Journal of Urology. Vol. 175, May 2006: 1817-1821; Arai Y., Aoiki Y., Okubo K., Maeda H., Terada N., Matsuta Y., Maekawa S., Ogura K. Impact of Interventional Therapy for Benign Prostatic Hyperplasia on Quality of Life and Sexual Function: A Prospective Study. Journal of Urology. Vol. 164, 1206-1211 October 2000.) In contrast Brooks et al. found that sexual function can improve after surgical treatment (Brooks S., Donovan J., Peters T., Abramas P., Neal D. Sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomized controlled trial. BMJ. Vol. 324, May 2002).
There are a wide variety of situations in which it is desirable to lift, compress or otherwise reposition normal or aberrant tissues or anatomical structures (e.g., organs, ligaments, tendons, muscles, tumors, cysts, fat pads, etc.) within the body of a human or animal subject. Such procedures are often carried out for the purpose of treating or palliating the effects of diseases or disorders (e.g., hyperplasic conditions, hypertrophic conditions, neoplasias, prolapses, herniations, stenoses, constrictions, compressions, transpositions, congenital malformations, etc.) and/or for cosmetic purposes (e.g., face lifts, breast lifts, brow lifts, etc.) and/or for research and development purposes (e.g., to create animal models that mimic various pathological conditions).
One particular example of a condition where it is desirable to lift, compress or otherwise remove a pathologically enlarged tissue is BPH. BPH is one of the most common medical conditions that affect men, especially elderly men. It has been reported that, in the United States, more than half of all men have histopathologic evidence of BPH by age 60 and, by age 85, approximately 9 out of 10 men suffer from the condition. Moreover, the incidence and prevalence of BPH are expected to increase as the average age of the population in developed countries increases.
The prostate gland enlarges throughout a man's life. In some men, the prostatic capsule around the prostate gland may prevent the prostate gland from enlarging further. This causes the inner region of the prostate gland to squeeze the urethra. This pressure on the urethra increases resistance to urine flow through the region of the urethra enclosed by the prostate. Thus the urinary bladder has to exert more pressure to force urine through the increased resistance of the urethra. Chronic over-exertion causes the muscular walls of the urinary bladder to remodel and become stiffer. This combination of increased urethral resistance to urine flow and stiffness and hypertrophy of urinary bladder walls leads to a variety of lower urinary tract symptoms (LUTS) that may severely reduce the patient's quality of life. These symptoms include BOO, weak or intermittent urine flow while urinating, straining when urinating, hesitation before urine flow starts, feeling that the bladder has not emptied completely even after urination, dribbling at the end of urination or leakage afterward, increased frequency of urination particularly at night, urgent need to urinate etc.
Although BPH is rarely life threatening, it can lead to numerous clinical conditions including urinary retention, renal insufficiency, recurrent urinary tract infection, incontinence, hematuria, bladder stones, and sexual dysfunction.
Surgical procedures for treating BPH symptoms include Transurethral Resection of Prostate (TURP), Transurethral Electrovaporization of Prostate (TVP), Transurethral Incision of the Prostate (TUIP), Laser Prostatectomy and Open Prostatectomy. Such invasive approaches, however, can negatively impact aspects of sexual function including erection and ejaculation.
Minimally invasive procedures for treating BPH symptoms include Transurethral Microwave Thermotherapy (TUMT), Transurethral Needle Ablation (TUNA), Interstitial Laser Coagulation (ILC), and Prostatic Stents.
More recently, a minimally invasive surgical approach involving employing an anchor assembly to compress the prostate and open the urethra has been found to be effective in treating BPH. This tissue sparing procedure is designed to retract encroaching lobes of the prostate to improve LUTS and flow rate.
There remains a need for the development of approaches and methods that can be used for various procedures where it is desired to lift, compress, support or reposition tissues or organs within the body for the purpose of treating sexual dysfunction. In particular, there is a need for an apparatus and approaches for manipulating prostatic tissue, the urethra, and surrounding tissues to specifically improve LUTS and sexual dysfunction.
The present disclosure addresses these and other needs.